Request for delinking of ICICIdirect trading account with Registered Intermediary Date: _______________ To, ICICI Securities Limited.

Shree Sawan Knowledge Park, Plot No. D-507, T.T.C.Ind. Area, M.I.D.C., Turbhe, Opp. Juinagar Railway Station, Navi Mumbai - 400 705. Dear Sir/ Madam, Sub : Delinking of trading account Ref : Trading Account number_____________________ I/ we refer to my/our above mentioned trading account registered through the intermediary who is a registered Sub Broker/ Authorised Person (strike whichever is not applicable) affiliated to I-Sec in the name and style of ____________________________ (hereinafter referred to as Registered Intermediary. I hereby request you to process my application as :(tick anyone of the below)

To become Online Client of the Registered Intermediary (

Permanently De-linking of my above mentioned trading account with Registered Intermediary.( )

In this regard, please find annexed/appended documents to process my above mentioned application. Annexure I: Migration Form (to become online client of the Registered Intermediary). Annexure II: No objection certificate from existing Registered Intermediary ( for permanently delinking of my account ). Thanking you Yours Sincerely ____________________ Signature Name

Annexure I Migration form to become online client of Registered Intermediary Date: _______________ To, ICICI Securities Limited. Shree Sawan Knowledge Park, Plot No. D-507, T.T.C.Ind. Area, M.I.D.C., Turbhe, Opp. Juinagar Railway Station, Navi Mumbai - 400 705. Dear Sir/ Madam, Sub: Migration from offline trading facility to online trading facility through the Registered Intermediary of ICICI Securities Limited (I-Sec) I/We refer to my/our www.icicidirect.com trading account bearing number ________________ registered through the intermediary who is a registered Sub Broker/ Authorised Person (strike whichever is not applicable) affiliated to I-Sec in the name and style of ___________________ (hereinafter referred to as Registered Intermediary. I/We am/are desirous of participating in the trading and investment facility offered by I-Sec directly through its website www.icicidirect.com and withdraw the trading rights granted to the Registered intermediary to deal on my behalf in my www.icicidirect.com trading account in any manner. However, I/We am/are desirous to authorize the Registered Intermediary to do various acts in connection with servicing issues pertaining to my / our aforementioned 3-in-1 account. In the course of my/our interactions relating to products and services of I-Sec, ICICI Bank Limited and/or its Affiliates or offshore entities, I/we expect that the Registered Intermediary will communicate with me/us in any manner, including without limitation, by telephone, email, SMS, fax, letter and in meetings. I/we confirm that I/we expressly request to receive each such communication from time to time. I confirm that all decisions to make investment(s)/avail of the aforementioned facilities or services from time to time are/shall be my/our independent decisions, and are not/shall not be made in reliance on any views or opinions, if any, as may be expressed by the Registered Intermediary from time to time, and are /shall be arrived at by me after personal analysis and careful consideration of the risks, benefits, terms and conditions taking in to account my/our investment objectives, financial situation and particular needs.

To enable the Registered Intermediary to provide the above services, I/we request I-Sec to provide the Registered Intermediary with an additional facility for the limited purpose of viewing the orders, transactions, statements, contracts, ledger balances concerning my/our aforementioned www.icicidirect.com trading account. I/we understand and agree that the change in the mode of operation of my/our above referred account will not affect my/our liabilities and obligations and I/we shall be liable for satisfactory completion of all transactions effected in my account prior to the change and shall continue to be so liable for all transactions effected in my account directly through www.icicidirect.com. Thanking you, Yours Sincerely,

____________________ Signature Name

Annexure II No Objection Certificate from the Registered Intermediary To, ICICI Securities Ltd. I / We have no objection in De-linking the www.icicidirect.com trading account bearing number __________________________ in the name of Mr./Mrs./Miss _____________________________________ ___________________________________ from my Node ___________________________. Yours Sincerely,

(Signature and Stamp of the Registered Intermediary) Name